Skip to:

FSPH's Dr. Fred Zimmerman discusses health care resource allocation with MLive

Deciding how to allocate health care resources in the U.S. isn't a question that should be left to the experts – it's a dialogue that should engage the whole community.

Wednesday, October 28, 2015

Deciding how to allocate health care resources in the U.S. isn't a question that should be left to the experts – it's a dialogue that should engage the whole community.

That is one of the take-away points from the DeVos Medical Ethics Colloquy on Monday, Oct. 27, presented by Grand Valley State University at the Cook-DeVos Center for Health Sciences.

Frederick Zimmerman, professor of health policy at UCLA, and Mildred Solomon, the president of the Hastings Center, addressed the ethical questions involved in allocating resources across the lifespan.

"Medical care is not free," Zimmerman said. "Ultimately, we are all paying for it. Therefore we all have a stake in how it is provided and how efficiently it's provided."

While a number of ideas have been proposed to measure or improve the efficiency of health care, Zimmerman said an open conversation is needed to move forward.

"I strongly feel it's not for experts to say what should happen. It's something that we all have to discuss," he said.

Solomon echoed that view as she cited issues with the current distribution of health care dollars. For example, she cited a need to emphasize cost-effective programs that have been successful in helping pregnant women and young children.

"Early pre-K, for example, is a very effective intervention, and it does affect life prospects, including health," she said.

For older adults, she said the current system creates "skewed incentives."

"We are prioritizing very expensive high-technology care and not at all supporting frail elders in their home or helping people age in place," she said.

However, discussing the allocation of health care dollars and incentives is not an easy topic.

"It is very hard for us in our country to even acknowledge that we need to set some priorities – I wouldn't even say limits - so we are spending more wisely," said Solomon, who directs Harvard Medical School's fellowship in medical ethics.

In the traditional American view, health care is seen as a commodity, she said. She called for a view that would balance individual choice with stewardship of resources.

"There is a role for expert knowledge and for studies," she said. "But it has to be a community-based process, where we are listening to one another with respect. And I think that is the hardest problem. We are in a state of great polarization."

Faced with a lack of national momentum on the issue, Solomon said there is an opportunity for local health systems to play a leadership role.

She cited the example of a health system that is asking patients to provide data that can be studied to find out what works, what doesn't and where health care dollars are obtaining the most value.

Zimmerman stressed the importance of focusing on health and public health – and not just medical procedures and treatments.

Housing costs, domestic violence, racial profiling, bike lanes, stress levels and other social and cultural factors have been shown to affect an individual's health and the ability to live a full life.

"Health has many different definitions," Zimmerman said. "One definition that is current in the field is that health is a resource for everyday living. When you think of it that way, it does involve some of these other issues."